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CS114
Challenges in Complex care: Managing pulmonary hypertension in progressive care
By: Laura Savage, Virginia Commonwealth University Health System, Richmond, VA
For further information, please contact: lsavage@mcvh-vcu.edu
Purpose: The goal of this project was to ensure a consistent method for training patients to manage complex therapies associated with pulmonary arterial hypertension. To achieve this outcome, a core group of specialty nurses was developed on the progressive care unit.
Description: Patients starting on new, complex therapies for PAH were admitted to a 20 bed progressive care unit. Therapies included Epoprostenol, Treprostinol and Iloprost. These require daily training of patients and their families. The regimen includes: mixing medication, managing a CADD pump and learning central line catheter care. Skilled observation of patient responses to medication is necessary. Staff must be aware of side effects of “too little” or “too much” drug and know how to intervene quickly. The goal was to develop competence and confidence in the progressive care staff. The CNS created “specialty nurses" by enlisting support of senior staff. A “recipe” for care was developed to ensure that all nurses were giving patients the same information. A cheat sheet for pump operation was developed with the input of patients and their families. Staff underwent hands on training consisting of medication preparation and setting up the continuous ambulatory pump. Staff role played “patient” and “nurse” to further develop skills and competence. After inservicing the CNS resourced staff during their first patient teach. Once staff demonstrated competence, the CNS covered patient care to provide nurses with uninterrupted teaching time.
Evaluation and Outcomes: When progressive care nurses provide training, length of stay (LOS) averages 3 days. As benchmarked with other PAH centers, LOS = 7 days or more. Specialty pharmacies send nurses into many of these hospitals to teach patients. Care is provided on the progressive care unit as opposed to a costly ICU. Finally, nurse satisfaction is high as they see patients progress from “novice” to “expert” in managing their own care.
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